[Percutaneous transvenous mitral commissurotomy with the Inoue catheter: the initial experience in Mexico]

Percutaneous transvenous mitral commissurotomy (PTMC) with the Inoue balloon catheter (IBC) was performed in 11 adult, symptomatic patients with moderately severe, pure of predominant mitral stenosis (MS). The transseptal approach and a valvuloplasty technique of progressive and controlled valvular dilatation were utilized. The procedure failed in one patient due to an inadequate transseptal puncture, and it was successful in the other 10. The mitral valve area increased from 1.00 +/- 0.27 to 2.19 +/- 0.31 cm2 (p less than 0.001); the diastolic mitral gradient decreased from 20.9 +/- 4.6 to 5.9 +/- 3.3 mmHg (p less than 0.001); similar reduction was obtained in the mean atrial pressure from 22.3 +/- 5.8 to 11.6 +/- 4.2 mmHg (p less than 0.001), and the mean pulmonary arterial pressure from 41.3 +/- 16.1 to 26.4 +/- 10.5 mmHg (p less than 0.05). There were no complications. Left to right shunting at the atrial level, due to the transseptal approach, was moderately significant in only 2 patients (QP/QS = 1.4 and 1.3 respectively). Grade I, and grade I-II mitral insufficiency occurred in 2 patients, one of them with previous mitral regurgitation, and it was not demonstrated or disappeared (if preexistent) in the rest. Patients were discharged in 48 hs at the most. They all referred improvement in their functional class, and at 4.3 months of average follow-up they are asymptomatic. In conclusion, PTMC with the IBC is a safe, simple and successful technique to separate the fused commissures, increase the mitral valve area and improve the functional class in selected cases of rheumatic MS. A long term follow-up is required for evaluation of late results.